ADHD, Childhood Experiences, and Borderline Personality Disorder In Young Adulthood: What Are the Links?

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Borderline personality disorder is a serious mental health disorder that affects the way someone relates to themselves and the world around them. It’s characterised by intense and unstable emotions, unstable personal relationships, and a shifting sense of self.

While borderline personality disorder is most often diagnosed during late adolescence, BPD doesn’t just suddenly develop. Instead, scientists think that interactions of certain biological features – particularly impulsivity and emotional sensitivity – with childhood experiences like social invalidation and trauma lead to the development of BPD.

Understanding the pathways to BPD is important because it allows mental health professionals, social workers, and other people to identify people at risk and provide interventions that make developing BPD less likely. Researchers have now identified several childhood characteristics and experiences that make developing BPD in young adulthood more likely.

Childhood ADHD and Adolescent and Adult BPD

Attention deficit hyperactivity disorder is a neurodevelopmental condition that’s common among children and sometimes continues into adulthood. It’s made up of two core dimensions: hyperactivity/impulsivity and inattention. Children with ADHD may have symptoms of both dimensions or one or the other.

Impulsivity is also a core feature of borderline personality disorder. Among young people with BPD, impulsivity can underlie risky behaviours, self-harm, and suicide attempts.

There is a lot of scientific research linking childhood ADHD – and especially the hyperactivity/impulsivity dimension – with BPD during late adolescence and adulthood. Studies have found that 50-75% of adults with ADHD had high levels of ADHD symptoms during childhood. Other research found that among a group of people with childhood ADHD, 13.5% went on to be diagnosed with BPD, compared to only 1.2% of others.

Scientists still aren’t sure exactly what links childhood ADHD to adult BPD, but they have several ideas. They think that impulsivity among young children (which is often inherited from parents) may be connected to emotional dysregulation – difficulty managing and calming emotions like anger, sadness, and fear. These traits are shaped and reinforced by childhood experiences, including maltreatment and family environments that invalidate emotions.

For example, behavioural difficulties caused by ADHD may lead to situations where a child’s emotional experiences are invalidated and responded to with punishment rather than empathy. This can cause more difficulties managing and calming emotions, making behavioural difficulties even worse.

ADHD and Self-Harm

Young people with ADHD in childhood are also more likely to self-harm when they are older, a common behaviour among adolescents and adults with BPD. Girls and women with impulsive ADHD are especially at risk of attempted suicide and non-suicidal self-injury. 

Research shows that symptoms of mood disorders and behavioural problems may partly explain the link between ADHD and self-harm, as well as victimisation by friends and social exclusion.

Executive Function in Childhood and the Development of BPD

Executive functions (EF) are cognitive skills that we use to control and select our behaviours to achieve our goals. They include working memory, self-control, planning, and problem-solving. Executive functions underpin fundamental aspects of daily life like learning, working, and relationships with others.

Adolescents and adults with BPD often have difficulties with certain executive functions, including planning, working memory, and response inhibition. Research suggests that children with executive function difficulties are more likely to have BPD as young adults, and those with EF difficulties and low socio-economic status are more likely to have features of BPD. In particular, girls with low executive functions and socio-economic status were at an especially high risk of developing BPD.

Experts suggest that the effects of low socio-economic environments on children with executive function difficulties could create conditions that make the development of BPD more likely. This means that they may benefit from specific interventions to improve executive functions and help protect against BPD symptoms later in life.

Internalising and Externalising Symptoms in Childhood and Adolescence

Internalising and externalising symptoms refer to two types of symptoms of mental health disorders. Internalising symptoms are symptoms that are mostly in someone’s inner world: such as moods, feelings, thoughts, memories, and pains. Externalising symptoms relate to the way someone behaves and affects the outside world, like inattention, impulsivity, aggression, or substance abuse.

Some mental health disorders involve mainly internalising symptoms, while others are mostly externalising. However, many mental health disorders involve at least some symptoms of both types.

Many studies have linked internalising and externalising in adolescence to adult BPD symptoms. While many people with BPD also have internalising and externalising symptoms, these symptoms often precede BPD rather than the other way around. Mood and behavioural symptoms may part of the developmental pathway to BPD during childhood and adolesence, leading ultimately to a diagnosable disorder.

Some research also shows that internalising and externalising symptoms in childhood also increase the risk of adult BPD. Experts think that emotional dysregulation may partly explain the link (difficulty managing and calming emotions), contributing to both internalising and externalising symptoms and features of BPD.

Trauma and Difficult Childhood Experiences

A large body of research links adverse experiences during childhood, including childhood trauma, to the development of BPD. Many scientists and other experts understand BPD as a response to these experiences. Some experts also suggest that the thinking and behaving patterns of BPD are actually a normal way to react to trauma and adversity, but ones that become maladaptive, harming a young person’s well-being rather than helping them.

Among other types of trauma, BPD is linked to childhood abuse, including sexual, physical, and emotional abuse. BPD features and diagnoses are also associated with having a parent with mental health problems, including depression and stress, and exposure to high levels of negative emotion from a parent.

Preventing the Development of BPD: Understanding Childhood Predictors

Identifying childhood experiences and characteristics that are linked to later BPD is important for us to gain a deep and comprehensive understanding of the disorder. But beyond this, it’s also an invaluable tool for its prevention.

Understanding the predictors of BPD allows social workers, mental health professionals, teachers, and other people to identify young people who are most at risk of developing the disorder. They can then provide interventions that help protect against the development of BPD in adolescence. 

These might include skills learning, such as executive function or emotional regulation skills, therapy for trauma and mood or behavioural symptoms, or social support that helps young people grow up in a supportive, caring environment. Some examples of interventions include:

  • dialectical behavioural therapy for children
  • parent-child interaction therapy
  • creative therapies

The Wave Clinic: Making a Difference in the Lives of Young People

The Wave Clinic is a specialist residential treatment space for young people. We offer trauma-focused programs for borderline personality disorder, eating disorders, and other mental health concerns. 

Our approach involves more than just exceptional clinical care. We focus on building futures and making a difference in the lives of young people through educational programs that teach academic, vocational, and life skills. We offer personal learning programs, vocational qualifications, internships, volunteering, enriching experiences, and the chance to learn and share skills with other people from different cultures.

Our space is located just outside of Kuala Lumpur, Malaysia. Young people live collectively in our main house, building relationships of mutual care and learning social skills as they continue their recovery journey. We offer specialist medical facilities for young people at the highest risk, including ICU beds and 24-hour medical monitoring.

If you’re interested in our programs, get in touch with us today. We’re here to make a difference.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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